Which of the following statement(s) is/are true concerning penetrating injuries to the colon and rectum?

a. A patient with 2 or more additional organs injured, significant fecal spillage, preoperative hypotension, or intraperitoneal hemorrhage exceeding 1 liter should not have a primary repair of a colon injury

The central issue in the operative management of colonic injuries is the controversy between primary repair of low-risk colonic injuries and repair or resection with exteriorization. Primary repair may be selected when additional risk factors have been excluded. Complications increase with primary repair when there is preoperative hypotension, intraperitoneal hemorrhage exceeding 1 liter, more than two additional organs injured, significant fecal spillage, or when more than six hours have elapsed since injury. Many patients with low-risk penetrating colon injuries can be treated with primary closure in the absence of these risk factors. High-risk colon injuries are those associated with severe injuries, as indicated above, and should be treated with resection and colostomy.

Rectal injuries should be suspected when there is any penetrating injury or a significant pelvic fracture. Sigmoidoscopic examination is essential. The principles of operative management include wide debridement of all dead and devitalized tissue and repair of rectal wall when possible. A totally defunctioning colostomy (not a simple loop colostomy) is necessary. Retrorectal drainage is indicated only in selected severe injuries. The distal stump should be washed out to evacuate the fecal contents. Broad-spectrum intravenous antibiotics, nutritional support, and serial debridements are also indicated.